E.Brehmer-AnderssonFig. 225 Lirytheadeema.« he epidermis is slightly irregular 1 the upper dermis there are dilsted iymphatics, many exttava sted red blood calls and a moderate number of iyrmphocytes the epidermis contains a ringle small vesicle. In the upper ‘nd Schaumburg-Lever 1990; Burton 1992; Preed hherg 1999). In investigations wf larger series of un: known the discussion on histopathol ogy has matnly dealt with the possibility of teacking the underlying disease (Thestrup. Pedersen etal. 1988; Zip et al, 1995; Walsh et al. 1994 Botella-Estxada ct a. 1094). "The most common pattern seenss to be that of 4 mild to moderate chronic dermatitis fy cases rep- resenting early T cell lymphoma, atypical T celle may be obscrved in the dermal inflammatory cell infiltrate and/or i the epidermis 22 Dermatitis Eczema) are id blood calle il nenly Formed vetcee. © An tres in the wpper dermis, which contains « conglomeration of proltferaung Wessels. d Clase-up shows both venules and eap> Tari, HE 2252 Example Case 4. Erythroderma: A 71-year-old woman presented with penicillin.in. duced ‘A punch biopsy included the dermal-subeutane- fous Interface. The epidermis was slightly irregular spangiotic, and contained one single small vesi- cle. ‘The latter contained a few lymphocytes and his ocyte-like cells (Langerhans cells?) The horny layer was normal. The papillary dermis was conspicuously edematous. The upper dermis contained, in addition tomany dilated thin-walled vessels, prominent groups fof newly formed vessels anda rich amount of extrava- sated erythrocytes. In the upper half of the dermis there were small, mainly perivascular infiltrates. of lymphovytes wits « slight admixture (Fig. 225). aos: Comment HEPIEREEEEE is on the whole a rare diagnocie I to tbtsin » biopsy specimen iy uncommon The expe tence of the author is limited; however, in every ease the author has bean confronted with the grea di crepancy between the clinical AH the microscopic Sppeerance has en a surprise. Ths was the fst re arto losin this sone before realcing that the most important changes afected the microvasculature, Be- Sides ciated thin-walled vessls there wes « marked proliferation of new vessels. Newly formed vessels are Ieaky and probably account for the massive extraves tion of erythrocytes in Case 4. If the presence of a high rhumber f newly formed veel in erythroderina Is 4 criterion, it may explain the findings of Groves et al. (1995) indicating significantly elevated levels of the circulating adhesion molecules ICAM-1, VCAM- 1 and ELAM-1 (E-selectin) in caused by poriasis a wll as by dermatitis (ecaems) These crema, HTB, SREGS A ‘in: Champion RH, Burton TL, Ebling FIG ) Rook/Wilkinson/Ebling textbook of dermatology Blackwell Scien, Oxford pp 584-585 4. Candiago 6, Marocolo D, Manganoni MA, Lea C, Fae chet F (2000) Nonlymphoidinrapidermal mononuclear cel collectiona(puendo-Pauiier abscesen). A morphologic “snd immianophenotypicl characterization, Am | Dermat: pathol 2-1-6 Freedberg IM (1995) Exfolitive dermatitis. i: Freedberg, 1M, Elen AZ, Wolf K, Austen KE Goldsnth Li Fpatric TB (ets) Titapateiks medicine. McGraw-Hill, New York, pp 534-540 6. Groves RW, Kepahi P, Barker [NWN, Hashard DO, Mase Donald DM (0995) Detection of creating adhesion mol cules in erythrodermic skin disease, } Am Acad Dermatol nants 7. LeBoit PE, Epstein BA (1990) A vaste shape character: ies the epidermal-mononuclear cell collections seen in spongiote dermatitis Arm J Dermatopathol 12:612-616 8. Lever WE, Schaumburg-Lever G (1990) Histopathology af the ki. LB Lippineot Philadephia 9. Rietchel RL (2001) Contact stomatitis ad ches, Ks Retichel RL, Fowl JF e (els) Fishers contact ders Lippincott Willams & Wilkins, Philadelphia, p 663-68 10, Sehgal VN, Srivastava G_ (1986) Exio tis, A prospective study of 80 patients. Dermatologica 7sa78-264 L. Thestrp-Pedersen K, HalklrSorensen 1, Sogaard H, Zachariae H (1988) The red man syndcom ‘atts of unknonen etiology’ «description and follow-up of $matiets Am Acad Dermatol 18-1307-1312 3. Burton JL (1 ive dormati- efointive der